How does DBT for Binge Eating Disorder work?
In the “Why Can’t I Stop Eating?” program participants begin by meeting with their individual therapist to identify symptoms of problematic eating. Many participants are surprised that the unhelpful way they approach food is actually shared by others. And that they are not alone.
Clients learn that while their binge eating feels impulsive, the way they use food actually follows a pattern. This pattern is related to deficits in dealing with difficult emotions. Clients learn how emotion dysregulation starts with an external or internal trigger. Triggers create negative emotions and result in binge eating due to insufficient coping skills and a low expectation that emotions can be handled this upset differently than they have in the past. At this point, the urge to stop the emotional suffering intensifies. Clients feel compelled to use binge eating which eventually returns them to a more regulated state.
Additionally, clients learn the role that binge eating plays in their lives.
Reasons for overeating are plentiful. Some may use overeating to keep others away, to avoid intimacy, to punish themselves or others. Some to cope with stress or to feel in control of something. Whatever the reason, we honor that the client faced a great difficulty in their life. At some point, he/she found some sense of safety and predictability through food, even if it was also unhelpful at the same time. When clients understand that they reacted in a way that made sense in the often powerless situations they were in, they begin to gain insight into overeating. Shame is reduced. Change can begin.
The therapy used to teach helpful skills is called Dialectical Behavior Therapy, (DBT). “DBT therapists accept clients as they are while also acknowledging that they need to change in order to reach their goals.”** DBT teaches clients helpful, positive and adaptive skills to manage emotions, get needs met and be effective. DBT has 4 modules: Core Mindfulness, Distress Tolerance, Emotion Regulation and Interpersonal Effectiveness.
Clients learn that DBT skills can be used to handle the emotions that are contributing toward urges to binge and perhaps restrict food. Clients also learn that emotions are useful as they communicate to ourselves, others and provide motivation to act.
Over time, as clients put skills in place to handle life’s challenges. They find harmful behaviors such as overeating are not so useful anymore.
At the same time that clients are gaining increased understanding of the emotional components of overeating. They continue work in both individual and group therapy to identify behavioral components that contribute to binge eating. Clients are asked to track food and drink intake for a small portion of the program. Simple tracking helps them to learn how regular meals and snacks are part of preventing later overeating. In fact, most clients with emotional dysregulation use problematic behaviors in the evening. Participants are also asked to keep a DBT Diary Card. Diary Cards help track feelings, urges to binge and the intensity of those urges.
Often depression and anxiety are also present for clients. These symptoms are addressed in individual therapy.
If needed, clients are also referred to psychiatry and registered dietitians with a background in eating disorders.
* Dialectical Behavior Therapy for Binge Eating and Bulimia by Safer, Telch and Chen.
** The Linehan Institute, Behavioral Tech Research, Behavioral Research & Therapy Clinics (http://behavioraltech.org/resources/whatisDBT.cfm)